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Sudden death due to metronidazole/ethanol interaction

S J Cina1, R A Russell, S E Conradi

  • 1Division of Surgical Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.

The American Journal of Forensic Medicine and Pathology
|December 1, 1996
PubMed

Insights

Metronidazole and ethanol can cause toxic acetaldehyde buildup, leading to cardiac issues. A fatal case highlights the risk of this drug interaction, even with minor physical trauma.

Area of Science:

  • Toxicology
  • Pharmacology
  • Forensic Pathology

Background:

  • Metronidazole, an antimicrobial, can interact with ethanol, causing acetaldehyde accumulation.
  • Acetaldehyde is a toxic metabolite known for hepatotoxicity and cardiotoxicity.
  • While disulfiram-ethanol reactions are documented, fatalities from metronidazole-ethanol interactions are rare.

Observation:

  • A case report details a 31-year-old woman's death following an assault.
  • Toxicology revealed elevated blood ethanol, acetaldehyde, and metronidazole levels.
  • The death occurred shortly after the assault, with minor physical trauma.

Findings:

  • The cause of death was attributed to cardiac dysrhythmia.
  • This dysrhythmia resulted from acetaldehyde toxicity.
  • The toxicity stemmed from a metronidazole and ethanol interaction.

Implications:

  • This case suggests a potential fatal risk associated with metronidazole and ethanol consumption.
  • Autonomic stress from the assault may have exacerbated the cardiac event.
  • Understanding this interaction is crucial for patient safety and forensic analysis.

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